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5840 East Evans Ave. Denver, CO 80222 PH: 303-300-6900 |
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| Health and Medical Care | |
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| Doctors | |||
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| Name | Address | Phone Number |
| Dentists: | ||
| Name | Address | Phone Number |
| Current Medications | ||
| Name of Drug | Dosage | How often Taken |
| Legal and Financial Information | |
| Location of important papers and documents: | |
| Will | |
| Living Will | |
| Power of Attorney | |
| Durable Medical Power of Attorney | |
| Heath Care Proxy | |
| birth Certificate | |
| Divorce Decree | |
| Property Deeds | |
| Safe Deposit Box | |
| Location of Keys | |
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| Sources of Income | |
| Income | Monthly Amount: |
| Social Security | |
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| Bank Accounts | ||
| Type | Name of Bank | Account Number |
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Phone Number
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Location of Acct Statements |
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| Annuities | |||
| Cert of Deposits (CDs) | |||
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| Name of Accountant/ Broker /Financial Planner | ||
| Name | Address | Phone Number |
| Insurance | ||
| Type | Company or Agent | Location of Policy |
| Life | ||
| Health | ||
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| Disability | ||
| Long Term Care | ||
| Dental | ||
| Homeowners/rental | ||
| Liability | ||
| Automobile | ||
| Funeral/Burial Instructions: |
| Clergy |
| Close Friends/Neighbors | ||
| Name | Address | Phone Number |